Provider Demographics
NPI:1801066568
Name:EBBS MEDICAL SUPPLY SERVICES INC
Entity type:Organization
Organization Name:EBBS MEDICAL SUPPLY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:EBENEZER
Authorized Official - Last Name:DURU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-986-4430
Mailing Address - Street 1:2340 E PACIFIC COAST HWY STE C
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-1571
Mailing Address - Country:US
Mailing Address - Phone:562-986-4430
Mailing Address - Fax:
Practice Address - Street 1:2340 E PACIFIC COAST HWY STE C
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-1571
Practice Address - Country:US
Practice Address - Phone:562-986-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EBBS MEDICAL SUPPLY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-08
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101338332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6063780001Medicare NSC